ABSTRACT

Objectives

Hematoma expansion (HE) is an important factor of unfavorable outcome in patients with intracerebral hemorrhage (ICH). Imaging markers on noncontrast computed tomography (NCCT) provide increasing value in the prediction of HE due to fast and easy-to-use advantages; however, the accuracy of NCCT-based prediction of intracerebral HE remains unclear. We aimed to investigate the predictive accuracy of NCCT markers for the evaluation of HE using a well-characterized ICH cohort.

Methods

We retrospectively analyzed 414 patients with spontaneous ICH, who underwent baseline CT within 6 h after symptom onset and follow-up CT within 24 h after ICH. Hematoma volumes were measured on baseline and follow-up CT images, and imaging features that predicted HE were analyzed. The test characteristics for the NCCT predictors were calculated.

Results

Of the 414 patients investigated, 63 presented blend sign, 45 showed black hole sign, 36 had island sign and 34 had swirl sign. In the 414 patients, 88 presented HE, the incidence was 21.26%. Of the 88 patients with HE, 22 presented blend sign, 11 showed black hole sign, 8 had swirl sign and 7 had island sign. The blend sign showed highest sensitivity (25.00%) and swirl sign showed the highest specificity (92.02%) among the four predictors. We noted excellent interobserver agreement for the identification of HE.

Conclusion

The four NCCT markers can predict HE with limited sensitivity, high specificity and good accuracy. This may be useful for prompt identification of patients at high risk of active bleeding, and prevention of over-treatment associated with HE.

Abbreviations

HE, hematoma expansion; ICH, intracerebral hemorrhage; NCCT, noncontrast computed tomography.

中文翻译：

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非对比计算机断层扫描成像标志物预测脑出血扩张的准确性。

摘要

目标

血肿扩大（HE）是脑出血（ICH）患者预后不良的重要因素。由于快速且易于使用的优势，非对比计算机断层扫描 (NCCT) 上的成像标记在 HE 的预测中提供了越来越大的价值；然而，基于 NCCT 的脑内 HE 预测的准确性仍不清楚。我们旨在使用特征明确的 ICH 队列研究 NCCT 标志物对 HE 评估的预测准确性。

方法

We retrospectively analyzed 414 patients with spontaneous ICH, who underwent baseline CT within 6 h after symptom onset and follow-up CT within 24 h after ICH. Hematoma volumes were measured on baseline and follow-up CT images, and imaging features that predicted HE were analyzed. The test characteristics for the NCCT predictors were calculated.

Results

在接受调查的 414 名患者中，63 名出现混合征，45 名出现黑洞征，36 名出现岛征，34 名出现漩涡征。414例患者中88例HE，发生率为21.26%。88例HE患者中，混合征22例，黑洞征11例，漩涡征8例，岛征7例。在四个预测因子中，混合征表现出最高的敏感性 (25.00%)，漩涡征表现出最高的特异性 (92.02%)。我们注意到在鉴定 HE 方面具有出色的观察者间一致性。

结论

四种 NCCT 标志物可以以有限的灵敏度、高特异性和良好的准确性预测 HE。这可能有助于及时识别活动性出血风险高的患者，并预防与 HE 相关的过度治疗。

缩写

HE，血肿扩大；ICH，脑内出血；NCCT，非对比计算机断层扫描。